General Medical issues thread

[Quickstatus]

Yes Three times a day, easier to take but why would people say it works better (more efficacious) rather than just easier to take

Interestingly no one has managed to determine the mechanism of action of paracetamol. We know it works but not how. Same with anaesthesia.

There is really good evidence on the other hand that says Nurofen Zavance is more effective than bog standard Nurofen because it's a different formulation and absorption is much faster.

 

[TheRealTMA]

Being higher dose (665 vs 500mg and I think slower release) it means 3 doses a day 8 hrs apart to get 24 hr coverage rather than needing to take a 4th dose in the middle of the night to get 24 hr coverage. I take mine at 7am, 4pm and 10 +/-pm

I find a single malt to wash down the paracetamol is useful.

 

[TheRealTMA]

Yes Three times a day, easier to take but why would people say it works better (more efficacious) rather than just easier to take

Interestingly no one has managed to determine the mechanism of action of paracetamol. We know it works but not how. Same with anaesthesia.

There is really good evidence on the other hand that says Nurofen Zavance is more effective than bog standard Nurofen because it's a different formulation and absorption is much faster.

FWIW. My old GP expressed severe caution with Nurofen (ibuprofen) in older patients.

 

[VPS]

FWIW. My old GP expressed severe caution with Nurofen (ibuprofen) in older patients.

what did he say about the single malt?

 

[TheRealTMA]

what did he say about the single malt?

Use in moderation.

 

[VPS]

Use in moderation.

Good thing you listen to him then

 

[RooFlyer]

Yes Three times a day, easier to take but why would people say it works better (more efficacious) rather than just easier to take

Dunno, but possibly because it was working better from them, as they weren't missing a dose and were getting a 24hr effect rather than stop/start if they missed the early morning dose f they chose 500mg.

 

[Quickstatus]

stop/start

Though the blood levels of paracetamol is actually more predictable in bog standard paracetamol, this is because the modified release Paracetamol absorption is unpredictable It can actually take more than 24hrs to dissolve in some people. It has 2 layers - the outer layer of the tablet is quick dissolving but it has an inner layer which is slow dissolving.

The risk of overdosage is actually higher as a result - which is why Panadol osteo is "pharmacist only" in AU/NZ

 

[drron]

I guess I am a slow dissolver. I take 2 Panadol Osteo in the morning with good effect. Taking a second dose up until 2000 has absolutely no extra effect so I continue with just my daily dose.

 

[tgh]

slow dissolver.

 

[RooFlyer]

Docs - for arthritis and joints I believe there are two sources of pain - 'bone against bone' where cartilage has gone and then inflammation around the joints.

I guess Panadol osteo is designed to mitigate the former? I have some degeneration in my SI joints (bone scan) and I can't tell that the Panadol does anything, but I do get cortisone injections for the inflammation which helps.

Actually, the best help is massage and dry needling by my physio as it seems the muscles around the joint are tight. Gives me relief for 2-5 days. So, I'm going to experiment (with GP's blessing) with the muscle relaxant Baclofen.

 

[Quickstatus]

I guess Panadol osteo is designed to mitigate the former

That's the problem. No one knows its mechanism of action. There is some evidence that it is an antiinflammatory but of a different mechanism that the usual NSAIDS.

 

[RooFlyer]

There is some evidence that it is an antiinflammatory but of a different mechanism that the usual NSAIDS.

If so, thought to have effect on kidneys? I'd like to take a lot more anti-inflammatories (such as Celecoxib) by my GP limits it, to protect kidneys. Bloods say they are OK but happy to leave it that way. I am taking the max does of panadol osteo, but not every day.

 

[tgh]

I am a bit surprised at the popularity of pain medications and the conversations above sent me reading..

The following article is just one perspective, I am sure there are more..

Andrew Moore, Honorary Senior Research Fellow, University of Oxford

Paracetamol has been around for over 50 years. It’s safe and many guidelines recommend it as the go-to treatment. At least, that’s the conventional view of the drug. It’s a view so ingrained that it’s rarely questioned. The trouble is that the conventional view is probably wrong.

Huge amounts of paracetamol are used to treat pain, measured not in how many tablets are used but in the thousands of tons. For the UK, an estimate of the amount of paracetamol sold is just under 6,300 tonnes a year. That’s 35 tonnes per million of population: 35 grams or 70 paracetamol tablets each, every year.

But does it work?​

The evidence is that it probably does not work at all for chronic pain. Large, good and independent clinical trials and reviews from the Cochrane Library show paracetamol to be no better than placebo for chronic back pain or arthritis. This is at the maximum daily dose in trials lasting for three months, so it has been pretty thoroughly tested.

 

[Quickstatus]

thought to have effect on kidneys?

Zero

Overdose = liver damage.

The evidence is that it probably does not work at all for chronic pain.

Agree
On the other hand, it is simple, cheap and if taken properly poses zero harm
If you like, It is the ideal placebo.

 

[XWu]

I am a bit surprised at the popularity of pain medications and the conversations above sent me reading..

The following article is just one perspective, I am sure there are more..

Andrew Moore, Honorary Senior Research Fellow, University of Oxford

Paracetamol has been around for over 50 years. It’s safe and many guidelines recommend it as the go-to treatment. At least, that’s the conventional view of the drug. It’s a view so ingrained that it’s rarely questioned. The trouble is that the conventional view is probably wrong.

Huge amounts of paracetamol are used to treat pain, measured not in how many tablets are used but in the thousands of tons. For the UK, an estimate of the amount of paracetamol sold is just under 6,300 tonnes a year. That’s 35 tonnes per million of population: 35 grams or 70 paracetamol tablets each, every year.

But does it work?​

The evidence is that it probably does not work at all for chronic pain. Large, good and independent clinical trials and reviews from the Cochrane Library show paracetamol to be no better than placebo for chronic back pain or arthritis. This is at the maximum daily dose in trials lasting for three months, so it has been pretty thoroughly tested.

You probably need to ask how the studies are done.

For example, say my 20 year old car’s engine is running noisy and sometimes lose power. I change my engine oil more regularly, seem to help with engine running and less power loss. When the next engine oil change is due and before I get a chance to do it, someone checked my engine and tell me it is still worn out and losing power. I tell him when I change engine oil I don’t expect the engine to become better, but it keeps the car going.

Same thing with Panadol or morphine or some other strong pain killers who doesn’t improve the disease that causes pain. People should be told that these pain killers helps them to keep moving, but when the pain killers wears off, they still get the same chronic pain not getting better. So what an amazing relevation and insight these researchers have when they conclude these things doesn’t improve pain when the pain killers wears off during the day (as compared taking placebo, again same pain at the same time all the time) and at the end of the drug trial.

Generally people are smart. If Panadol doesn’t work at all they stop taking them and ask the doctor for a stronger pain killer. There are plenty of people who do get some pain relief with Panadol. If this is placebo, hell, bring it on more placebo, I don’t mind more of it.

BTW Panadol osteo supposed to be coated for sustained release but at the end of the day, 6 osteo tablets is the same dose as 8 normal tablets (the latter regularly on discount $2 or 3 for a box of 100 Panamax at chemist warehouse although nowadays they don’t let you buy more than one box and it’s behind the pharmac_ counter)

Zero

Overdose = liver damage.


Agree
On the other hand, it is simple, cheap and if taken properly poses zero harm
If you like, It is the ideal placebo.

Actually even at maximum “safe” dose of 8 X 500 = 4 grams a day can lead to liver damage if you take it long term (even in just a few months at max dose for some, apparently certain people have livers that are genetically more sensitive to it than others) so it’s better to wean down or even stop for a few days or weeks when pain is not too bad rather than to rely on it as a crutch to start the day

 

[Quickstatus]

Actually even at maximum “safe” dose of 8 X 500 = 4 grams a day can lead to liver damage if you take it long term (even in just a few months at max dose for some,

Exactly. "Taken properly" = always read the product instructions at back of box :

 

[JohnK]

Just want to encourage you @JohnK.

I have both my knees replaced - one in 2003 at the age of 43, the other in 2015 at the age of 55, both due to very severe osteo arthritis.

....

A positive attitude will win out every time. It's only as bad as you let it feel.

Apparently my knees look perfect on the x-ray. No osteoarthritis. The ligament looks very good. Better than what's expected for a 61 year old.

My issue must be the weight or the pain transferring down from both hips with osteoarthritis. (I've managed to find a way to stand up from sitting position without suffering extreme pain. Twist the right knee and lower leg then get up. It's like getting up with no weight on right knee)

As for being positive that's difficult to do when life just drags you down down at every opportunity. But still there are others worse off.

 

[blackcat20]

First offspring broken bone yesterday. Miss TC fell off the bars at school. Instead of waiting hours at emergency I took her to one of the new urgent care centres, we were straight into x-ray and out the door within an hour. Nice buckle fracture just below the wrist so no cast required, and we've purchased an arm brace for her to wear for the next 2-3 weeks.

 

[RooFlyer]

I have just had the most unpleasant 'medical' experience in all my life and would appreciate medico's considered advice.

I've just had a CT guided steroi_ injection into into a sacroiliac joint. it is my fourth such injection in the past six months into various joints, Done at the same place.

I arrived early and the orderly took me in early got me prepped and I lay face down on the CT table while he marked me up and took the initial scan. I said that I had arthritis in my toes and fingers and a prop was put under my feet which helped a bit. Then there was a long wait until the radiologist came in with the other orderly and started preparing the injections.

To be honest, I couldn’t give you a number of minutes I was waiting lying there but I know it was considerably longer than all the other procedures I’ve had at that place. Clearly, they tried to do the efficient thing and get me prepped in plenty of time so the radiologist could work efficiently. Howeve in the meantime, I was extremely uncomfortable lying face down with arthritic toes and fingers and unable to move. I made some comments about the uncomfortable wait to the orderly which I didn’t think were of much consequence but were obviously taken with offence as me complaining about being held up and having to wait.

What happened next was just extraordinary. The doctor began to berate me for rudeness and the way I treated his staff. He sounded angry said he said he was angry. Voice was not raised but clearly angry. I think he said he was minded to stop the procedure and I could go if I wanted to. By this time I already had the first needle into my backside and still laying face down and I have not yet seen his face.

Throughout the procedure he continued with very short terse statements and was clearly still angry. I started to say something but he cut me off.

He said I could complain, but he was the owner of the business with 15 years experience and I was getting some of the best treatment I would ever get anywhere.

finally, I was able to get a word in edgeways. I moved up onto my elbows and he put his face about 1 to 2 feet away from mine as I was lying down and continued to make it plain he was unhappy.

I was able to sit up and I explained that I thought there had been a misunderstanding and I wasn’t complaining about simply having to wait. It was that I thought I need not have been put on the table quite so early and uncomfortable before the radiologist was ready. That’s all, and I mentioned that I’ve been here three times previously for the same procedure.

With a bit more back-and-forth and with an apology for me for any offence he was mollified a bit and also apologised to me. He insisted on hugging me ( yes, really).

I realised I was red and flushed and my heart was going very quick. I left the room quickly and got changed and went out to Reception to find him there and he told me he was bulk billing the procedure. Normally about $650 with about $250 out of pocket. I declined as I didn’t want to be beholden into them, but they said no it was done and dusted.

You might assume that what I said was probably a little bit worse than what I’ve said here but absolutely never rude or aggressive or really complaining (but obviously it was taken as complaining).

I found being in the middle of a procedure where the doctor is putting a needle down into your rump into a joint while he was angry very frightening.

Now, a couple of hours after the procedure I a dull ache or throb at the procedure site which in my experience is unusual as there is a local anaesthetic applied so I don’t know what’s happening there. I'm now lying on my stomach which I’ve never had to do before.

So my questions are:

* should I make a complaint to some authority? The complaint would not necessarily be that he was angry at me but that we have a doctor here who lost control and was angry and continued with a procedure while berating the patient.

* If so, what organisation should I complain to?

* I would state the facts as best I can rely on on notes I made shortly afterwards coming out.

* or would I be wasting my time? Would the college of radiologists if there’s such a thing really care or do anything material?

Doctors are welcome to DM me with any advice if they wish.